While the aging network has been moving towards evidence-based disease prevention and health promotion programs for the past several years, the FY-2012 Congressional appropriations now require that OAA Title IIID funding be used only for programs and activities which have been demonstrated to be evidence-based. The full final appropriations language is copied below with the key provision bolded.

For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 (“OAA”), section 398 and title XXIX of the PHS Act, section 119 of the Medicare Improvements for Patients and Providers Act of 2008, $1,473,703,000: Provided, that amounts appropriated under this heading may be used for grants to States under section 361 of the OAA only for disease prevention and health promotion programs and activities which have been demonstrated through rigorous evaluation to be evidence-based and effective: Provided further, That none of the funds provided shall be used to carry out sections 1701 and 1703 of the PHS Act (with respect to chronic disease self-management activity grants), except that such funds may be used for necessary expenses associated with administering any such grants awarded prior to the date of the enactment of this Act: Provided further, That the total amount available for fiscal year 2012 under this and any other Act to carry out activities related to Aging and Disability Resource Centers under subsections (a)(20)(B)(iii) and (b)(8) of section 202 of the OAA shall not exceed the amount obligated for such purposes for fiscal year 2010 from funds available under Public Law 111–117: Provided further, That notwithstanding any other provision of this Act, funds made available under this heading to carry out section 311 of the OAA may be transferred to the Secretary of Agriculture in accordance with such section.

The new requirements outlined in the FY-2012 awards (NOAs) apply only to those funds. Contracts made with previous award funds, e.g., FY-2011 funds, do not have to be altered. That said, multi-year contracts which began prior to FY-2012 may have to be altered depending on whether such contracts include activities that meet at least the minimal criteria for evidence-based Title IIID programs.

There are exercise programs that meet the criteria for evidence-based and those may be substituted for programs that do not meet at least the minimal criteria outlined in FAQ #2 above. For a list of evidence-based exercise programs go to http://www.ncoa.org/improve-health/center-for-healthy-aging/physical-activity/community-programs.html.

One source of funding may not be sufficient to meet all the disease prevention and health promotion needs of clients. Partnership and collaboration can extend the reach of health promotion programs. Many States, Tribes, AAAs, and PSAs use Title IIID funding to leverage other funds. It is common practice to braid or blend funding streams to fund different components of the same activity in order to make a complete program. Depending on the health promotion program, funding sources may include: public health departments, hospitals, foundation giving, universities, Cooperative Extension System Offices (USDA), professional organizations (such as pharmacy, dental and dietetic associations), United Way, voluntary donations, private donors, Medicare, Medicaid, outpatient clinics, non-profit organizations, federally-funded health centers, city parks and recreation departments, sliding scale co-pay, and others.

States, Tribes, AAAs, and PSAs leverage many other funding sources and in-kind contributions for Title IIID programs including both public and private entities. Other key federal funding sources are the Substance Abuse and Mental Health Services Administration, Centers for Disease Control and Prevention, and the US Department of Agriculture. In addition to partnerships outside the Aging Services Network, some AAAs have pooled their Title IIID funding and implemented regional and/or statewide evidence-based programs.

State Administration is based on the full Title III allocation and can be charged to any of the parts of Title III. As provided in OAA, Sec. 308(b), each state may determine the amount of Title III funds, including Title IIID, it will use for State plan administration activities up to 5% of its Title III allocation or $500,000, whichever amount is greater.

OAA Title IIID is intended to initiate programs designed to help older adults prevent and/or manage chronic diseases and promote healthier lifestyles. Healthy aging reduces healthcare costs and increases quality of life for older adults.

Evidence-based programs are shown to be effective at helping participants adopt healthy behaviors, improve their health status, and reduce their use of hospital services and emergency room visits. Older Americans are disproportionately affected by chronic disease. Evidence-based programs can mitigate the negative impact of chronic diseases and related injuries, such as falls.

Evidence-based programs empower older adults to take control of their health by maintaining a healthy lifestyle through increased self-efficacy and self-management. Evidence-based initiatives provide the greatest impact given available funding. Before the OAA Title IIID evidence-based requirement was implemented in 2012, States, Tribes, AAAs, and PSAs had already begun to shift their Title IIID funding towards evidence-based approaches to achieve better results for their limited funding.

No. The reporting requirements for Title IIID have not changed. The State Program Report (SPR) does not require any client level reporting for Title IIID, but a State Unit on Aging may include them in their “total persons served” count. To view the AoA Program Results and Evaluation resources, visit: http://www.aoa.gov/AoARoot/Program_Results/index.aspx

Yes. The Chronic Disease Self Management Program along with all other evidence-based health promotion programs, are an acceptable use of Title IIID funds. A list of evidence-based programs that can be supported by Title IIID funds can be found at http://www.ncoa.org/improve-health/center-for-healthy-aging/. Note: The list at this site is not exhaustive and does not include programs meeting only the minimal criteria for Title IIID evidence based programs.

The AoA regional office is able to assist States and AAAs with implementing disease prevention health promotion programs that meet the new requirements. Many health promotion programs currently being implemented already meet the minimal evidence-based criteria, such as health screenings, oral health programs and vaccinations.

States are required to deliver Title IIID funding via the approved interstate funding formula (Note: Some states may have a separate section of the IFF for Title IIID funding that goes to “medically underserved areas” rather than to all AAAs.). In the event an Area Agency on Aging is unable to meet the new Title IIID requirements after receiving the funds via the IFF, States would have to follow their own written policy regarding programmatic compliance and reclamation of funds.

Older Americans Act, Sec. 102.(a)(14) defines the term disease prevention and health promotion services. As seen below in bolded green text, the term evidence-based health promotion was added to Sec. 102(a)(14)(D) of the OAA in the 2006 Amendments.

• The term “disease prevention and health promotion services” means—
  1. health risk assessments;
  2. routine health screening, which may include hypertension, glaucoma, cholesterol, cancer, vision, hearing, diabetes, bone density, and nutrition screening;
  3. nutritional counseling and educational services for individuals and their primary caregivers;
  4. evidence-based health promotion programs, including programs related to the prevention and mitigation of the effects of chronic disease (including osteoporosis, hypertension, obesity, diabetes, and cardiovascular disease), alcohol and substance abuse reduction, smoking cessation, weight loss and control, stress management, falls prevention, physical activity and improved nutrition;
  5. programs regarding physical fitness, group exercise, and music therapy, art therapy, and dance-movement therapy, including programs for multigenerational participation that are provided by—
     1. an institution of higher education;
     2. a local educational agency, as defined in section 14101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 8801); or
     3. a community-based organization;
  6. home injury control services, including screening of high-risk home environments and provision of educational programs on injury prevention (including fall and fracture prevention) in the home environment;
  7. screening for the prevention of depression, coordination of community mental health services, provision of educational activities, and referral to psychiatric and psychological services;
  8. educational programs on the availability, benefits, and appropriate use of preventive health services covered under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.);
  9. medication management screening and education to prevent incorrect medication and adverse drug reactions;
  10. information concerning diagnosis, prevention, treatment, and rehabilitation concerning age-related diseases and chronic disabling conditions, including osteoporosis, cardiovascular diseases, diabetes, and Alzheimer’s disease and related disorders with neurological and organic brain dysfunction;
  11. gerontological counseling; and
  12. counseling regarding social services and follow up health services based on any of the services described in subparagraphs (A) through (K). The term shall not include services for which payment may be made under titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq., 1396 et seq.).

Some activities included at health fairs, such as health screenings, do qualify as evidence-based and are therefore an acceptable use of Title IIID funding. However, for health fair activities that do not meet at least the minimal criteria of evidence-based as outlined in the AoA multi-level definition for IIID, other sources of funding or in-kind contributions will have to be used. A few examples of health fair activities that do not meet at least the minimal criteria of evidence-based, include sports competitions, health information booths, and demonstrations.

OAA Title IIIB funds can be used as well as Administration funds. Some communities have obtained donated services and/or found volunteers for activities such as informational booths, walk-a-thons and exercise demonstrations. By inviting local organizations to host a booth, give a presentation or offer a demonstration, they receive free marketing and in return provide a health fair activity free of charge. These activities could include: presentations on healthy diets and grocery shopping tips by a nutritionist paid for by a local grocery store; healthy cooking demo hosted by a local restaurant; benefits of stretching demo by a local gym instructor; presentation on building healthy relationships by a local therapist, psychiatrist, psychologist or psychotherapist; alternative medicines demo by a local acupuncturist, massage therapist or herbalist; bicycle and pedestrian safety demo by a local partner of the National Bicycle Safety Network; back health demo by a local chiropractor; CPR and First Aid demo by local EMTs; dental care presentation by a local dentist or dental hygienist; and skin cancer prevention demo hosted by a local dermatologist.

No. AoA uses a tiered set of criteria for defining evidence-based interventions implemented through the OAA. Health promotion programs can fall within any of the three tiers, including minimal and intermediate criteria. While the goal is for all Title IIID activities to move toward the highest-level criteria, programs meeting the minimal or intermediate criteria do meet the new evidence-based Title IIID requirements.

Yes. In order to meet the highest-level criteria you must have already met the minimal and intermediate criteria. Think of the graduated set of criteria as a check list, as you check off each bullet your evidence-based health promotion program is moving further towards meeting the highest-level of evidence-based criteria posed by AoA.

Yes. For more information on a number of evidence-based Care Transition programs, visit AoA’s PowerPoint presentation at: http://www.aoa.gov/Aging_Statistics/docs/AoA_ACA_CT1_slides_012411.pdf

AoA does not require prior approval or documentation to be submitted regarding evidence-based health promotion programs. However, AAAs and SUAs may want to retain documentation of the evidence behind their chosen Title IIID health promotion program(s) for their own records. Depending on the program, this could be anything from a copy of an appropriately credentialed practitioner’s certification (e.g. nutritionist, pharmacist, dentist, CNA, LPN, etc.), to a peer-reviewed journal article, to dissemination products.

For a Title IIID evidence-based health promotion program meeting the minimal criteria such as blood pressure screenings at a health fair, documentation could include a copy of the CNA, LPN, RN or other performing practitioner’s license number along with information about the blood pressure screenings that were performed. In the event student volunteers are used, such as dental students, nutritionists or pharmacists, a letter or email from the faculty instructor could be retained as a record of the evidence-base of the health promotion program implemented with Title IIID funds.